Wednesday, June 5, 2013

If you talk to any recent med school graduate they will
often have all kinds of advice regarding how to approach the dreaded residency
interview circuit. When it comes time to
sell yourself to future employers in order to shore up a job upon graduation, the
advice varies and is often contradictory, just as personalities vary and often
contradict. Interviews can be fun and
terrible at the same time. You meet
dozens of applicants from around the country, listen to program directors sell
their individual programs, and smile.
Always smile. And for those who
knew me, they seemed to always add that I should try staying awake while
smiling. I guess because smiling with
your eyes closed is sort of creepy. But
these ended up being my first two pillars of good interviewing which I feel necessary
to pass on to future generations. It
seems simple enough, but there exists a fundamental principle of attending
multiple interviews. The first interview
is exciting. Then the next four—or twenty-four—interviews
after that are all exponentially more exhausting. You begin digging deep within the sacred
reserves of your soul to keep both mouth corners and eyelids peeled in upward
fashion. Interviewing for residency is
like the smiling Olympics. You feel
confident going in, but then quickly realize you are up against a lot of
world-class gunners…uh, I mean
grinners. But smiling and staying awake
aren’t enough. It was actually on my
fourteenth interview, when I was fast losing hope that I would even be counted
among the finishers, that I discovered a third pillar of success. Do not forget your socks.

Yes, everyone should learn early on to make a list of things
to pack on every interview. This keeps
you from forgetting things like cellphone chargers and toiletries. But in my case, it didn’t save me from
showing up in Portland without socks. So
my name is Jay, I am now a physician and surgeon in training, and earlier this
year, I showed up to an interview having forgotten to pack my socks. This is my story.

Just to be clear, I did not actually show up in a new city
without any socks. I had white tube socks, because I was
forward-thinking enough to pack athletic gear since I was training for a
triathlon at the time. I ran five miles
on a treadmill the night before my interview, and the socks I wore for that run
were both fantastic and fully present
in my suitcase. The footwear problem did
not surface until the morning of my interview when I woke up, quickly showered,
and donned my gray suit and tie. After
checking my smile in the mirror, I discovered that my dress socks were incredibly
absent from my suit case. It was an hour
before I was scheduled to be at my interview site, but being the cool character
that I was, I did not panic. I knew I
had the tube socks, so I tried those on first.
A quick glance in the mirror immediately revealed that wearing white
tube socks with a gray suit makes your ankles look like they are glowing in the
dark whenever you sit down. I recall
this realization coincided with the onset of my panic. I tore off my socks and evaluated myself
without any socks at all. Though naked
ankles were marginally better than glow-in-the-dark ankles, I determined that
showing off your ankles is not a pillar of good interviewing. I began to panic some more. So I hurried downstairs to my hotel front
desk.

The next few discoveries I made were perhaps just as novel. When you ask the front desk worker if they
carry extra socks, this is equivalent to asking for a ride to your interview in
a kangaroo. Their eyebrows are at first
too askew to give you a straight answer.
Only after explaining that I had a job interview in an hour and had
forgotten my dress socks did I get a straight answer. The answer was no. It was a very polite no, and the lady was
even kind enough to call a few drug stores just to confirm that nobody was awake
at five in the morning to sell me socks.
This is when I began running scenarios in my head. If I went to my interview sockless, should I
take a proactive approach and mention to my interviewers that I was not bearing
my ankles on purpose? Or do I just play
it cool and hope that nobody notices the flesh between the end of my pant leg
and the lip of my shoe? Is being a guy
who forgets socks better than being a guy who goes au naturel in his nice shoes? These were terribly complex questions that my
brain was not prepared to answer at five in the morning. Maybe I could try pulling my suit pants down so
low as to minimize my ankle exposure? But
then is sagging your suit pants better than flashing your naked ankles? I felt like I was trapped in this awful game
of non-hypothetical would-you-rather.

I’ve often heard artists talk about inspiration striking
when they least expect it. And while I
have never considered myself any sort of an artist, my muse must have been close
by that morning. Amidst the tightening
grip of my panic, I suddenly had a desperate thought. I turned back to the lady at the front desk
and this time asked for (or perhaps demanded) a pair of scissors. She gave me a curious look, but handed me a
pair without question. I grabbed my
suitcase and darted to a corner of the lobby.
I pulled out a gray long sleeve t-shirt—the exact one I had worn during
my previous night’s run. I glance
quickly at the shirt sleeves and knew they were my only hope. With a few imprecise snips, I was able to
detach the sleeves from my t-shirt, quickly fashioning a pair of poor man’s leg
warmers. I slipped my heel into these
and pulled the end halfway up my calf.
They were ill-fit and baggy, but when I stepped into my shoes, they gave
the impression of socks. I tied a knot
in the upper end of these cloth tubes to better fit my calves and returned the
scissors with a triumphant thank you.
The lady was nice enough to not ask questions, although I was quite sure
she had unknowingly witnessed what was perhaps the most inspired moment of my
medical school career.

I made it through the entire interview day without incident,
though I did have to adjust my makeshift ankle coverings a few times because
they kept coming lose and drooping.
Honestly, after interviewing at over a dozen locations, all the flights,
the faces, and the formalities tend to become somewhat of a giant blur. But of all the cool experiences I do
remember, slicing the sleeves off a t-shirt to make leg warmers is definitely
one of my favorites. Thus my three
pillars of having a successful interview season are this: smile, stay awake,
and socks. Super easy to remember and
guaranteed to improve your performance.
You know how they say when life gives you lemons, you should try making
lemonade? I think the truth is that in
life, we are often the ones gifting ourselves with lemons. The whole adage is just an elegant way of
saying that we all have a stupid version of ourselves whose sole purpose is to
collect lemons and dump them on us at the most inopportune times. Our only hope is that when our brains are
working at some measurable capacity, we can come up with a passable recipe for
lemonade. But of course, it makes much
more sense bring socks to an interview than to make t-shirt-sleeve-dress-sock
lemonade.

Friday, May 24, 2013

I haven’t posted in many, many months. For those I have spoken to in person, you may
know that this past year has been simultaneously one of the best and worst of my life. All rolled into one joyfully aching mess. I matched into
University of Washington’s surgery program, I graduated from med school, and I even completed an ironman distance
triathlon up in Napa Valley. Truly, it
has been an amazing journey, but one where celebration seems constantly
juxtaposed against personal loss and mind-numbing grief. I am learning to ride the highs and the lows
and if nothing else, learning to put one foot in front of the other. There is so much to say but there is also
nowhere to begin.

I think when things are going well, it is hard to grasp how
imperfect life can be. That is the
beauty of healing—that a collection of good and pure moments can wipe away past
darkness, no matter how immersive that darkness may have once been. In happiness, we all tend to forget what pain
is. In celebration, in tender moments,
in joy, we are allowed to
forget. So the past four years of med
school have in many ways been the happiest of my life. And in many ways, without getting into
details, I was totally unprepared for my personal life to fall apart.

I think sometimes I am under the false impression that with
talent, hard work, and with commitment to character, we can eliminate
misfortune. True joy seems invincible,
and that is why it is called joy. But no
journey is without stormy stretches. Life
is humbling, and at times it will bring you to your knees. It is unfair and incomprehensible, and during
such times, if nothing else, you learn to crawl. Because that is all you can do. And as your knees scrape the ground, for
periods you might even wonder if you will walk again. Because pain can also seem invincible. The kind of pain that seems to drown out hope and beckons forth shadows from every corner. Real pain.

I am learning that when life brings you to your knees, you just have to learn to crawl. I guess the
paradox has always been that without pain, there can be no empathy. Hope, and comfort, and healing only matter to
those who have been taken to their knees.
For those who know what it is to crawl.
Life is humbling, and it is unfair, and there are people who crawl for
an entire lifetime. So I’m learning. Because it is not only in war that we must find it in us to crawl. But also in love.

Thank you to all my friends, to all my family, and to all who have walked (and perhaps crawled) beside me, no matter how briefly. To you I owe the world.

Monday, July 16, 2012

The old man stood about a foot shorter than the others gathered in his clinic. This
made the tarnished streaks in his silvery hair easy to spot, but he still
combed it so that the thin ivory strands stretched across the barren areas of
his scalp. It was like this every morning. Perhaps what
time and experience had not provided him in stature, it had offered back in
depth. Years of refinement and wear—buried in his
eyes. It was such that his age reflected most profoundly not from
the specks and the creases of his skin, nor from the tarnish in his hair, but
from a shadowy well within those eyes. A flickering, rippling depth
that you could catch brief glimpses of, magnified through the thick lenses
framed upon his nose. And it was with those eyes, and in spite of
his height, that he peered keenly down at those around him. He spoke
bluntly, moved deliberately, and gave orders without wasting words on common
courtesies. His thick Vietnamese accent delivered his speech in
rolling jabs that never quite crossed the line into rude. But his
presence—his quiet, cavernous presence—brushed uncompromisingly against my
senses. It was the entirety of this old man’s presence that
irritated me from day one.

Together, we were perhaps nothing if not an ill-formed
match. An intense, eager, yet green medical student teamed with an
intense, stubborn, and seasoned family physician. It was determined
from the start that I would prove myself to this old man. And from
the start, I quickly realized this man had no desire to prove anything to
anyone. The pace and fashion in which he worked was fixed,
mechanical—like a piston, or maybe a turbine set long ago—still steadily
driving and being driven by the charts, the exams, the
prescriptions. With a quick flurry of questions, a few inquisitive
glances, and a practiced touch, he moved from patient to patient until the
lights in the waiting room dimmed and it was time to clock out. It
was an inertia built up over a lifetime. And the unwavering force
with which it moved caused everything around it to bend. I imagined
how in his twenty-seven years of working at the same clinic, he had witnessed
everything around him evolve. Computers being installed, electronic
records being implemented, new systems, new nurses, new policies, and new
technology—all buzzing in a colorful blur around him. And I imagined
him standing calmly in middle of it. An aging yet unmoving
constant. Like an ocean carving fissures into the side of a
mountain, the old man’s steady presence swelled up against those around him,
causing all of us—patients, nurses, and me—to bend and abide.

“Good morning, Doctor Pham.” I offered the same
greeting each morning as he walked into the clinic. A brief nod and
a thin smile indicated his readiness. For six weeks, we operated
just as we were—two entities set into motion sixty years apart. We clocked
in at the same time each day and clocked out one right after the other each
night. Yet in all the time and space bracketed between these choreographed
bookends, we managed to operate side by side, but never quite
together. It was as if the inner workings of his faded exterior
hummed in constant disharmony to some of my most basic values. And
as a result, my frustration simmered beneath a thinning
patience. Only behind closed doors and beyond the old man’s ear
would I allow it to escape in harsh whistles from every pore of my
skin. But for the most part, I kept my grievances a secret smolder,
hidden from the old man yet fanned daily by watching him practice his stiff,
spindling brand of medicine. There was something in the jaded
physician’s disposition that must have been forged fiercely long ago, and as a
result presented itself more rigid and ill-fitting than might otherwise be
expected. For patient after patient left the clinic having battled
in those hurried moments to steal from the man some small resolution to their
private concerns, only to be blown backwards by the invisible force of his
forward-churning style. It was a style driven by the weight of his
unbending disposition which he yielded with a mechanical ease. And
it stood upon that oceanic depth which pooled within those black eyes, guarded
behind the thick frames which he cleaned intermittently on his coat
sleeve. The grand effect was an undertow that remained placid at the
surface, but swept rippling hues of frustration through the old clinic and
clean out the door. In a way, I drew a strange comfort from noticing
this. Every clenched jaw and furrowed brow meant that the agitated
secrets which bristled beneath my façade were being shared among others who happened
into the old man’s dusty wake.

I turned the ignition and with one last pained sigh, my truck
pulled out of the parking lot, away from the faded white building and the
sunburnt sign that simply read “clinic.” I didn’t look back as I
drove away that final time, and seldom have I since. The irritation
that circulated within me for six weeks gradually dwindled and eventually
vacated altogether. Perhaps to haunt some other host. But
every now and again, I can’t help but think about the old man. In my
less restful nights, I wonder if maybe it wasn’t really his disposition or
demeanor that clashed so harshly against my own, but rather the injustice of
time itself—strewn across his every wrinkle and draped in his every
movement. It was an injustice largely shifted in my favor during the
snapshot of our interaction, and magnified by the coincidence of our
proximity. By the nature of my youth, time still presented itself as
a dimension soft and moldable, like clay. Yet being next to the old
man provided proof that this would not forever be the case. For the old
man, his allotment had already been shaped. Only the last intricate
details remained to be sculpted, and as we stood beside each other in
that clinic, we stared from opposite ends of time’s unforgiving canyon, eyes
fixated on different sights within its depths. And perhaps it was
exactly this difference in perspective—this ever-shifting injustice—that
irritated me most deeply. When I think back to the old man, I wonder
if all the discomfort I harbored poured forth from a more basic
anxiety. A fear that the time grasped before me might solidify
before I can mold within it a fraction of my dreams. It seems to me
that youth has an easy way of staring into the canyon of time, giving little notice to the ledge on the other side, and the old man who will one day
stand upon it.

Thursday, June 21, 2012

About a year ago, I was having lunch with a friend when the
subject of finding a good doctor came up. What makes a good doctor?
What qualities are most valued? My friend leaned forward and asserted, “I
really don’t care if my doctor is nice and all that stuff, I just want the
freakin’ smartest doctor I can find.” I pressed my lips into a
half-smile. I didn’t agree with her at the time, but I found my ability
to counter lodged somewhere between my heart and my throat. The truth is,
when I started medical school, I felt much the same way. Who cares if a
doc pats you on the shoulder and comforts you? Who cares if she smiles
and asks you about your wife, kids, and pet zebrafish? To me, all this
was much like the toy that comes with your kid’s meal—a delightful bonus, but
not the real substance of medicine. I just wanted someone to do the right
tests, give me the right meds, and send me on my way—fixed up and ready to
go. But even in the first few months of my training, I could see that my
initial impression of good medicine was rather short-sighted. It seemed
odd that on one hand, I was a proud member of a fraternity that prides itself
on stratospheric test scores and intellectual acrobatics. Yet on the other
hand, I was beginning to see that brute intellect plays only a small supporting
role in medicine’s celebrated script. For many of us, this comes as a
hard pill to swallow. But the truth is it doesn’t take a genius to be a
great doctor.

Part of the problem for both patients and providers alike is that
we often view illness as a technical difficulty. If our computer crashes, we
expect the whiz at Apple to uncover the problem and provide the restorative
reboot. If our car crashes, find us a skilled mechanic who can dive under
the hood and give it new life. Hell, if the economy crashes, we believe
the officials we elect to office should have the power to tweak a few policies,
rejigger the interest rate, and get our GDP rocketing skyward again. And
why not? We are of a bold generation that has always viewed even the most
complex problems as a giant brain away from happy resolution. But what if
a loved one gets sick? And what if it’s my child—not my computer—who’s
crashing? Often, our initial intuition is the same. Employ
the smartest doctor in the hospital to swap a few meds, execute some elaborate
surgery, and restore everything back to normal. A doctor’s job is to fix
our cracks and mend our leaks so we can get on with our lives. And presumably,
the smartest ones are also the best fixers. But of course, matters of
life—and death—are never quite so simple.

Despite whatever value we assign to our beloved gadgets, laptops
don’t think, and cars don’t feel. They also don’t dream, aspire, believe,
defy, invent, or imagine. It’s the fingers that touch a keyboard that
possess the ability to translate the ideas and emotions of a brazen mind.
Cars carry passengers, but it’s the passengers who carry a lifetime of joys and
sorrows. And when an economy crashes, it’s the people who suffer, not the
GDP. So while flawed devices and failed policies can be restored and
renewed, they can also be discarded. Human beings—well, not so
much. This is the real grit of medicine. We can preserve health, but
not indefinitely. We can treat pain, but we don’t cure misery.
Despite all our medical advances, more often than not, our job is not to
fix, but to advise, to advocate, and to comfort when suffering has already
established a foothold. The brilliant engineer must decipher when old
parts should be abandoned and outdated systems replaced. The great
physician—she must walk with the worn, and sit with the broken. And it’s
not that we should disregard the breadth of her knowledge. It’s just that
there is truly no replacement for the depth of her compassion.

For those of us who still view illness as technical blip, it’s
likely because we have never been truly sick or cared for the gravely
ill. Yes, we’ve probably taken antibiotics for a throat infection or
received x-rays for a broken bone. Maybe even gone through surgery and
rehab for certain injuries. But the most common and costly diseases
afflicting Americans are the unsexy, life-sapping diagnoses that prompt years,
even decades, of suffering. Diabetes, depression, heart disease,
cancer—all chronic diseases without cure. If you spend enough time around
doctors, you will hear them refer to treatment as “medical management.”
Because in cases of long-standing illness, it isn’t about coming up with
dazzling answers or pondering over a mysterious case until reaching that single
“aha!” moment. You work with patients to juggle a dozen prescription pill
bottles. You remind patients why they can’t eat their favorite foods—the
ones they’ve grown up enjoying. You even prepare patients for how
chemotherapy will cause them to lose their hair, their hearing, their sex
drive, and much of their independence. And you help them understand why
once your health leaves you, it doesn’t often come back. Because
for patients whose lives are marred by poor health, medicine becomes more about
dedicated support, compassionate care, and constant education. It turns
out the ability to perform high-flying mental acrobatics is really just a
bonus. Like that toy that comes with your kiddy meal. When you are
truly famished, your focus shouldn’t be on the toy.

The truth is that for many patients, they come to a doctor sick,
and leave sick. And for 365 days a year, they are the ones taking care of
themselves. Physicians don’t get to play miracle healer as often as
they’d like. Instead, the challenge is how to better empower patients to
choose for themselves the lives they want to live, even when illness has become
a part of everyday reality. I know if someone I really cared about got sick,
there are some people in my class I would trust without hesitation. Not
because they are brilliant, though most of them are. But because they are
the type of people that you can trust to carefully guide you while
understanding that your diagnosis is not your defining characteristic.
For those who are truly ill, there are often many tough decisions with few good
outcomes. And the “right” decision is different for each
individual. Because after all, we aren’t just a collection of moving
parts, all mass-produced from the same mold. We harbor unique thoughts,
values, and aspirations. And all of these things play into excellent
care. Clearly, amputating a pinky finger might mean one thing to me, and
something very different to a concert pianist. Simply put, there are
“good” answers, and then there is true guidance. The latter is what
distinguishes the outstanding physician. It may not require the gift of
pure genius, but it demands a level of human compassion that is perhaps every
bit as rare.

Thursday, June 7, 2012

“It doesn’t have to look
pretty,” my resident grinned as he slipped out of the room, pass the sliding
glass doors. I looked up from the
half-tied knot that was securing the gown to my waist. “Alright,” I nodded. Around me, the whirlwind of alarms that compliments
most ICU beds had ceased. I lifted a
needle holder off my patient’s lap, grabbed the needle that had been laid out
for me, and loaded it. The room was now
dim, aside from the lamp that hovered at arm’s length above me. It draped white over my shoulder and onto the
wound I was prepared to close. My gaze
slid along the serrated fibers of muscle which framed a crude window cut
between two ribs. There, through the
gaping slit in this man’s side, a piece of the lung stared out at me. And at the top corner of this window, just
beneath the breastplate, a fleshy corner of his heart peered out as well. I lowered metal to flesh and watched the
needle take its first bite. His body was
still warm.

Wednesday 9:12 p.m. My trauma pager had gone off. Instinctively, I squelched its beeping, shuffled
to the nearest elevator, and descended down to the emergency room. There, I met up with the rest of my team and
listened as a nurse on the phone provided updates. A patient had been found down by the side of
the freeway. He was en route by
helicopter. We stationed ourselves
around the designated room, waited, and made small talk. Fifteen minutes went by. Then a pale, unresponsive man was wheeled
into the trauma bay with a medic crouched above him performing CPR. “This is a thirty-year-old John Doe… jumped
out of a vehicle moving at highway speeds… unresponsive with agonal breathing
when first responders arrived… heart stopped beating in transport.” As the medic gave his report, a curtain of
providers descended in a synchronized flurry upon the patient. From my position at the edge of the room, I
watched as the trauma resident grabbed a scalpel, sliced open the chest, swept
the lung aside, and began compressing the heart. The patient’s intrinsic heartbeat returned
and within seconds, we were in an elevator on our way to the operating room.

I could hear the steady rhythm
of my breaths cycling beneath my facemask.
It was punctuated momentarily by the click of my needle holder as it
seized the metal tip at the surface of the skin. I pulled another stitch through, gave it a
tug, and felt the thread bite into my palm.
Slowly, the edges of the wound began to ease together. Across the man’s chest, the suture spiraled
silver—diving in and out, back and forth, from the breastplate to just beneath
the nipple before jumping off the skin and onto the needle at the end of my
instrument. The rest of the wound stood
open from this point. It widened
underneath the armpit before tapering back down to a corner where the patient’s
frame rested against the bed. I looked
at the half that remained open, re-angled the light above me, and continued
working.

A bead of sweat dripped down
the side of my cheek and dissolved into my facemask. I fastened one last knot, cut the remaining
suture, and set my instruments down.
With a damp cloth, I wiped the dried blood off the newly closed
wound. I stepped out from underneath the
lamp light and glanced at the closure.
The suture that held the incision together resembled the seam of a
baseball, only knotted within the flesh of this man’s chest. In some ways, it looked every bit as unnatural
as when it lied open with organs visible between flaps of skin and tissue. I turned toward the door, shed the protective
layering I had on, and stepped back into the heart of the ICU. My resident looked up from his seat. “I’m done,” I informed him.

Thursday 12:53 a.m. I propped
myself on a step by the patient’s chest.
He had made it through surgery only to have his heart stop twenty
minutes after arriving in the ICU. My
resident was calling out orders from his position at the bedside as nurses
zipped in and out of the room. I could
hear the practiced calm in his voice.
“Alright, take over,” he instructed, stepping away from the bed while
continuing to run the code. I began
chest compressions. Our attending surgeon
slipped into the room, exchanged a few words with the resident, and moved to
re-open the patient’s chest. I took my
hands off the breastplate. Reaching for
the lamp above me, I focused it on the thoracotomy. The attending cut the sutures, spread the ribs
apart and reached in. A nurse handed him
a small paddle connected to a defibrillator.
He positioned it on the heart’s surface and everyone stepped away from
the bed. A shock was delivered. Nothing.
The attending stuck his hand back in the chest and resumed cardiac
compressions. After two minutes, we
tried the defibrillator again, followed again by internal CPR. Still nothing. “Fuck,” I heard someone whisper. After nearly thirty minutes the doctor stood
up. “Let’s call it.” The bustling stopped. A nurse’s voice floated above the whirring
and beeping of machines, “You want me to hold the epi, then? Okay, we’re calling it. Everyone, time of death: one twenty-three.” We all stripped off our gowns and filed out
of the room, quietly.

Out of the corner of my eye, I
could see where my patient’s body lay beyond the glass pane—motionless under
the glow of the examination light I had forgotten to turn off. My resident stepped into the room, took a
cursory look, then popped back out. “It
looks good, man.” I smiled and thanked
him. It seemed strange accepting a
compliment for placing stitches in a dead man.
But before I could mull it over, two women led by a nurse entered the
ICU.

One was older, and the other
much younger—maybe a mother and a sister.
I couldn’t be sure. The nurse led
them to the room’s entrance, slid the glass door open just wide enough, and
whispered something inaudible. The
guests nodded and the nurse stepped away, leaving them alone. I eyed the older woman as she paused at the
doorway. The younger one—she must have
been the daughter—took her mother’s hand and together they stepped into the
room. Both paused a few feet from the
bed. Then deliberately, the sister
glided right up to the bedside and slipped her hand over his. I watched her tremble and for a moment I
tried to focus my gaze elsewhere. Then
the sister lowered her face into the man’s shoulder and began to sob. This time, I looked down at my keyboard and
didn’t look back for some time. But I
could hear her faint whimper through the opening in the glass door.

Thursday 2:10 a.m. I was slouched in front of a computer in the
ICU. My fingers scampered in syncopated
bursts across a keyboard and underneath the weight of my eyelids, the ICU faded
out… then in… then back out again.
Through this sweet haze of thinly formed sleep, I heard the approaching
footsteps of my resident. “You want to
close the thoracotomy?” The fluorescent
lights of the unit rushed back into focus.
“Yeah, I’ll do it,” I heard myself respond. It was almost a reflex. I had never closed a thoracotomy before, but
as a student, I wasn’t in the habit of passing up such opportunities. “Okay, everything you need is already in the
room when you’re ready. Let me know if
you need help or anything, but it’s pretty simple. I mean, it’s just got to stay closed. Don’t worry about making it pretty, you know.” He picked up a chart and continued walking.

The exam light remained
illuminated in the dim room, its single beam never wavering from the wound that
I had closed. Even as family members
mourned in the darkness, I could see every insignificant detail of my suture
gleaming from behind the glass. Under
the spotlight, the wound seemed to glow as some strange memento of our hollow
impact. All our efforts had amounted to
essentially nothing. And as officials
from the coroner’s office sealed the body bag, I held in my head images of his
dropping blood pressure, his frenzied surgery, the rosy color of his lung, and
the numbers on the clock when we pronounced him dead. These things I knew, but really I knew
nothing. I knew nothing of how a story
of thirty years had unfolded. Or what
thread held together the chapters of a life I had watched unravel in a few dark
hours. I was only there to place the
last few stitches, and stand in the shadows as fresh wounds opened in the lives of those who knew
enough to mourn.

Eventually, the night faded into
nothing, and with it our empty efforts.
Yet all the details remained imprinted in my mind as a reminder of
medicine’s harsh reality. I’ve been
lucky enough to stand alongside heroes who pour their hearts and minds into
providing some small amount of healing where it is needed most. I’ve seen them labor and sometimes limp in
their efforts to create some meaningful impact in the lives that intersect with
their own. All the while knowing that the
stakes are high and their best may in large part be forgettable. But they push forward in spite of this. If for no other reason than because it is
their singular privilege to do so.